First Online: 06 December 2010Received: 28 April 2010Accepted: 06 December 2010

Abstract

BackgroundLow molecular weight LMW heparins are used for anticoagulation during hemodialysis HD. Studies in animals have shown that LMW-heparins release lipoprotein lipase LPL as efficiently as unfractionated UF heparin, but are less able to retard hepatic uptake of the lipase. This raises a concern that the LPL system may become exhausted by LMW-heparin in patients on HD. We have explored this in the setting of clinical HD.

MethodsTwenty patients on chronic hemodialysis were switched from a primed infusion of UF-heparin to a single bolus of tinzaparin. There were long term follow up of variables for the estimation of dialysis efficacy as well as of the LPL release during dialysis and the subsequent impact on the triglycerides.

ResultsThe LPL activity in blood was higher on tinzaparin at 40 but lower at 180 minutes during HD. These values did not change during the 6 month study period. There were significant correlations between the LPL activities in individual patients at the beginning and end of the 6 month study period and between the activities on UF-heparin and on tinzaparin, indicating that tissue LPL was not being exhausted. Triglycerides were higher during the HD-session with tinzaparin than UF-heparin. The plasma lipid-lipoprotein levels did not change during the 6 month study period, nor during a 2-year follow up after the switch from UF-heparin to tinzaparin. Urea reduction rate and Kt-V were reduced by 4 and 7% after 6 months with tinzaparin.

ConclusionOur data demonstrate that repeated HD with UF-heparin or tinzaparin does not exhaust the LPL-system.

List of AbbreviationsHDhemodialysis

HDLhigh density lipoprotein

LDLlow density lipoprotein

LMW-HEPARINlow molecular weight heparin

LPLlipoprotein lipase

UF-HEPARINunfractionated heparin

TGtriglycerides

AVarterio-venous

KT-Vcalculation of weekly dialysis dose performed

LDLlow density lipoprotein cholesterol

HDLhigh density lipoprotein cholesterol

CRPC-reactive protein.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2369-11-33 contains supplementary material, which is available to authorized users.